Major Level-Funded Carriers
The level-funded market includes national carriers (UnitedHealthcare, Cigna, Aetna, Anthem), regional carriers, and specialty level-funded carriers. Each carrier's product differs in: (1) stop-loss structure (specific and aggregate attachment points); (2) claims data access (some provide full claims data; others provide limited data); (3) surplus sharing (some return surplus; others do not); and (4) network options.
Product Evaluation Criteria
| Criterion | What to Look For |
|---|---|
| Stop-loss structure | Specific attachment point; aggregate attachment point; carrier financial strength |
| Claims data access | Full claims data access; analytics tools; benchmark comparison |
| Surplus sharing | Percentage of surplus returned; timing of surplus distribution |
| Network options | Network breadth; direct contracting options; reference-based pricing options |
| Renewal process | How renewals are priced; experience rating vs. manual rating |
Carrier Financial Strength
IQ Insight
Carrier financial strength is a critical evaluation criterion for level-funded plans. The stop-loss carrier must be able to pay claims when they occur. Evaluate the stop-loss carrier's AM Best rating (A- or better is preferred) and financial reserves. A level-funded plan backed by a financially weak stop-loss carrier is a significant risk.